Provider Demographics
NPI:1467779512
Name:CARIBBEAN VASCULAR SERVICES PC
Entity Type:Organization
Organization Name:CARIBBEAN VASCULAR SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTINEZ TRABAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-908-7645
Mailing Address - Street 1:604 CALLE FELIPE
Mailing Address - Street 2:MANSION REAL
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2640
Mailing Address - Country:US
Mailing Address - Phone:787-908-7645
Mailing Address - Fax:
Practice Address - Street 1:909 AVE TITO CASTRO
Practice Address - Street 2:TORRE MEDICA SAN LUCAS STE 602
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4728
Practice Address - Country:US
Practice Address - Phone:787-651-1429
Practice Address - Fax:787-651-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR142412086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028195Medicare PIN